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General NPI Number Information
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NPI Number | 1851882898
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Entity Type | Organization
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Legal Business Name | LATITUD 18 NORTE LLC
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | CARR 796 KM 0.3 BO RIO CANAS SECTOR LA GUASABARA
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 939-204-9030
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Fax | 939-204-9029
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Provider Business Mailing Address
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Address Line | GRAN VISTA I 51 CALLE LA CEIBA
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City | GURABO
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State | PR
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Zip | 00778
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Country | US
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Telephone | 787-600-0283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BENIGNO DOMINGUEZ
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Credential |
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Telephone | 787-600-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 20-F3553
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License Number State | PR
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